May 22, 2019
By Zhen Xu, PhD Candidate, Therapist
Imagine living in a world in which everyone feels free to talk about their therapy sessions openly without judgement, as they do about dentist or physiotherapy appointments. Although psychotherapy is a common practice in some cultures, this scenario is unheard of in the Asian immigrant community in which discussions of mental health are hushed, therapy is shunned, and seeking help takes tremendous courage. Not only is heavy stigma associated with mental illnesses, feeling shame and guilt for having a mental health issue also makes Asian immigrants reluctant to get help. Additional cultural challenges, such as the desire to “keep it in the family” or “not washing dirty linens in public” (to prevent outsiders from discovering one’s mental health issues), fear of being ostracized by their communities, seeking help as being seen as a “weakness”, concerns of confidentiality, and the possibility of losing “face” or bringing shame to their families can further prevent them from even acknowledging/admitting that they are experiencing mental health problems (Chen, Kazanjian, & Wong, 2009; Thomson et al., 2018; CBC/Radio Canada; 2018).
Back in their countries of origin, their main supportive networks may consist of close family members, friends, and co-workers. Immigration to a new country can significantly reduce the accessibility of social support networks in their home countries, which can greatly increase their vulnerability to mental health problems. It can be difficult to find new sources of support in a foreign country, yet many are still resistant to getting help. It has been shown that Canadians of Asian ethnicities are the least likely to utilize mental health services in their communities (Durbin et al., 2015; Li & Browne, 2009; Tiwani & Wang, 2008).
Due to possible linguistic barriers, strong feelings of shame, guilt and denial deeply rooted in cultural values, visiting a psychologist is usually seen as a last resort in Asian immigrant communities. Receiving professional help is often seen as taboo and people who experience mental health problems live in fear of being labeled as “crazy” or “insane”. Refusing to seek help or dropping out prematurely during psychological treatment is common. Symptoms of those who make it to the psychologist’s office are often more severe and more difficult to treat than Canadians of other origins (Fang, 2010). In addition, Asian immigrants may mistake psychosomatic symptoms for physical illness due to the importance and attention they give to physical health, yet they lack awareness of, or perhaps avoid, issues related to mental health.
Furthermore, there may be numerous misconceptions in the Asian community of what a clinical psychologist does and the services that he/she can offer, possibly due to media and/or cultural beliefs. For many Asian immigrants, psychology comes across as a western subject matter, with treatment values and perspectives developed in western individualistic cultures that focus on improving the life of the individual. This may be in direct contrast to collectivistic cultural values, which are more typical of Asian cultures, in which focusing on self-improvement may be viewed as selfish and even induce guilt.
Finally, the role of psychologists can be drastically different in their home countries compared to that in Canada. In some countries where the profession of psychology is young and not as well regulated, immigrants may have experienced different and perhaps ineffective psychological treatment, which misconstrues the potential benefits of psychological services. In Canada, psychologists must be licensed with their provincial regulation boards (e.g., Order of Psychologists in Quebec) and must have strict academic and clinical credentials to be eligible to do so. If you are looking for a psychologist who fits your patient’s needs, visit the official website of the Order of Psychologists of Quebec to find a suitable match: http://www.ordrepsy.qc.ca/.
So what can we do as health practitioners to help immigrants overcome stigma and find the help that they need?
1) Normalize seeking help from psychological services in Canada and encourage them to look for a psychologist within their provincial regulation board (e.g., the Order of Psychologists of Quebec)
2) Reduce the stigma by encouraging them to think of psychological problems as getting a “cold” psychologically. Encourage them to seek help instead of letting symptoms drag on until the issue becomes a psychological “fever” (more severe)
3) Encourage immigrant populations to seek out community support – e.g., at their local community and cultural centres that offer support services in their language of preference
4) Assist them in utilizing community and online resources to educate themselves about issues related to immigration and mental health.
5) Address “the elephant in the room” – racism and discrimination issues that immigrants often face
6) Practice cultural sensitivity when seeing clients of a different cultural background. Be curious and willing to learn about your clients’ issues and try to understand their cultural context
7) Provide psychoeducation regarding the close association between one’s physical and mental health
8) Utilize cultural consultation services such as: https://www.mcgill.ca/tcpsych/clinical/ccs
CBC/Radio Canada. (2018, March 1). ‘The unspoken ones’: How race and culture complicate Asian-Canadians’ access to mental health care [News Release]. Retrieved from https://www.cbc.ca/radio/thecurrent/facing-race-the-current-s-town-hall-event-in-vancouver-1.4558134/the-unspoken-ones-how-race-and-culture-complicate-asian-canadians-access-to-mental-health-care-1.4558354.
Chen, A. W., Kazanjian, A., & Wong, H. (2009). Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry, 46(4), 623-641.
Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC health services research, 15(1), 336.
Fang, L. (2010). Mental health service utilization by Chinese immigrants: Barriers and opportunities. Canadian Issues, 70.
Li, H. Z., & Browne, A. J. (2009). Defining mental illness and accessing mental health services: Perspectives of Asian Canadians. Canadian Journal of Community Mental Health, 19(1), 143-159.
Thomson, M. S., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: a review of barriers and recommendations. Journal of immigrant and minority health, 17(6), 1895-1905.
Tiwari, S. K., & Wang, J. (2008). Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada. Social psychiatry and psychiatric epidemiology, 43(11), 866.